Stanley L. Handelman

The clinical predictability of internal derangements of the temporomandibular joint

The value of clinical parameters as predictors of the arthrographic findings in patients with temporomandibular joint (TMJ) pain and dysfunction was examined in this study. We developed a series of simplified clinical prediction rules based on previous studies correlating clinical signs and symptoms with arthrographic diagnosis of the condition of the TMJ meniscus. One hundred eighty-six patients with signs and symptoms of TMJ dysfunction were clinically examined before TMJ arthrography. Arthrograms were performed on 246 joints (126 unilateral, 60 bilateral). The rules predicted 91 of the 246 joints to be normal when actually 59 were shown to be normal arthrographically. The rules slightly underpredicted those patients with positive arthrographic findings for internal derangements. Although there were some individual variations in the predictability of unilateral versus bilateral arthrograms (patients), there was very little overall difference, 58% and 60%, respectively. This study confirms previous suggestions that clinical findings alone are not consistently accurate in diagnosing the exact type of TMJ internal derangements depicted by arthrographic criteria.

Prevalence of drugs causing hyposalivation in an institutionalized geriatric population

The types and numbers of drugs prescribed for nursing home residents were enumerated in order to determine the prevalence of drugs that cause hyposalivation. Drugs were coded as having a definite or probable hyposalivatory side effect, or as having no effect, and were also categorized by therapeutic action. The average number of drugs prescribed for each patient was approximately four. Approximately half of the institutionalized elderly received one or more drugs with a hyposalivatory side effect. The hyposalivatory drugs were mainly antipsychotics, antidepressants, antihistamines, and analgesics.

Comparison of internal derangements of the TMJ with occlusal findings

Two hundred five patients were examined because of temporomandibular joint pain and dysfunction. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). No significant differences were found between arthrographic groups with respect to Angle classification, horizontal and vertical overlap, posterior tooth wear, missing posterior teeth, cuspid-protected occlusion, balancing-side contacts, deflective occlusion, and clenching of the teeth. Tilted teeth on the contralateral side were more common in cases of reducing meniscal dislocation than in cases of normal meniscus position or of nonreducing meniscal dislocation.

Mandibular range of motion versus arthrographic diagnosis of the temporomandibular joint

The range of mandibular movements has been correlated with arthrographic findings of the temporomandibular joint in 205 patients. Abnormalities of meniscus position and function have been found to influence mandibular movements in characteristic patterns. However, altered mandibular movements alone are insufficient for a definitive clinical diagnosis of the specific type of internal derangement of the temporomandibular joint.

Inhibition and Killing of Oral Bacteria by Silver Ions Generated with Low Intensity Direct Current

Silver cations generated by passing low intensity direct current through pure silver electrodes were found to be sufficiently antibacterial to cause sterilization of samples of infected dentin. The optimal procedure involved a 5 μA current applied for 20 minutes with the anode then left in contact with the sample. Minimal inhibitory concentrations of electrically generated silver ions for representative oral bacteria were essentially equal to those for silver ions added as nitrate or fluoride salts, and medium constituents, including sodium thioglycolate, antagonized antibacterial action. A major advantage to the use of the electrode method is that it allows for continuous, focal application of antibacterial silver cations.

Correlation of clinical parameters to the arthrographic depiction of temporomandibular joint internal derangements.

This prospective clinical investigation of 188 patients with signs and symptoms of temporomandibular joint (TMJ) pain and dysfunction examines the correlation between clinical signs and symptoms versus the arthrographic characteristics of intracapsular disease related to displacement of the meniscus. An attempt has been made to establish which specific clinical signs and symptoms, as determined by arthrography, best predict the condition of the joint. Our findings suggest that most of the clinical signs and symptoms are not sufficiently reliable in themselves to permit prediction of the condition of the meniscus. Those clinical parameters that did show a strong correlation were tested in combinations using stepwise discriminant analysis to evaluate clinical tendencies. Thus, patients with normal meniscal position and function were often noted to have normal mandibular ranges of movement, no joint noises on opening and closing of the jaw, and no tomographic evidence of degenerative joint disease. Subjects with meniscal displacement with reduction were often found to have joint clicking, deviation of the jaw upon opening, and an absence of degenerative joint disease by multidirectional tomography. Patients who had meniscal displacement without reduction were often found to have limitation in jaw movement, crepitation on opening and closing of the jaw, and associated degenerative changes on multidirectional tomograms. If specific treatment plans are to be tailored for different stages of TMJ internal derangements, clinical findings alone or clinical findings in conjunction with plain radiographs of the TMJ are not consistently accurate.

Effect of Daily Application of Fluoride in a Custom Fitted Mouthpiece on Plaque Flora Associated with Dental Decay

Plaque samples examined before and after daily application of acidulated fluoride gel in custom fitted mouthpieces showed no changes in the prevalence of organisms in selected bacterial categories associated with dental decay.

Use and quality of bitewing films in private dental offices

Patient records (387) were obtained from twenty-five dentists in private practice in Rochester, New York. The number and types of radiographs taken at each recall examination in the most recent 10-year period were recorded. Bitewing radiographs were taken at 50.5% of the recalls with size 2 film used most frequently (83.7%). The average recall interval was 8.4 months overall and 18.0 months for bitewing recalls. Of all proximal surfaces available on the bitewing films, 68.2% were judged adequately separated for diagnostic purposes. For individual surfaces, the highest percentages were recorded for the mesial surface of the maxillary second premolar (89.9%) in the permanent dentition and for the distal surface of the mandibular second molar (83.7%) in the deciduous dentition. Taking four bitewing films instead of two improved the percentage of adequately separated proximal surfaces at a given recall by 2% to 25%. The percentage of unreadable proximal surfaces caused by overlapping or distortion on the bitewing radiographs, when excluding the canines, ranged from 6.3% to 39.5% in the permanent dentition and from 12.5% to 24.9% in the deciduous dentition.

Michael Buonocore and the Eastman Dental Center: A Historic Perspective on Sealants

Dr. Michael Buonocore is known for his innovative research on the preparation of the enamel surface with a weak acid to enhance adhesion of an organic plastic chemical sealant and the polymerization in situ of a sealant with ultraviolet light. His co-workers at Eastman Dental Center aided and extended his research findings. The purpose of his original research was the development of a sealant to prevent occlusal caries on posterior teeth. However, the major impact of his work has been the development of adhesive restorative techniques. Although it has been demonstrated that (i) bacteria tend to die out and caries does not progress if early caries lesions are inadvertently sealed, (ii) sealant retention rates are favorable, and (iii) sealants are cost-effective, the use of sealants by the profession is still far short of early expectations.

Comparison of arthrographic findings of the temporomandibular joint with palpation of the muscles of mastication

Abstract Two hundred five patients were examined for temporomandibular joint pain and dysfunction and specifically for tenderness to muscle palpation. Arthrograms were performed on 222 joints (188 unilateral and 17 bilateral). Significant findings were ascertained for the middle portion of the temporal muscle in “normal” patients versus “with and without meniscus reduction” patients. The superficial masseter muscle was more tender in “normal” patients and in “reducing meniscus” patients than in “without meniscus reduction” patients. The medial pterygoid muscle was more tender in “normal” patients and in “without meniscus reduction” patients than in “reducing meniscus” patients. Though there are some significant findings with respect to muscle palpation, by itself muscle palpation is not a specific indicator of temporomandibular joint internal derangement.